Among patients with more than three episodes of recurrent C. difficile infection who could not tolerate jejunal catheter or suffered anal incontinence, a single dose of an oral suspension of fecal microbes delivered through several dozen 0.47 mL gel capsules resolved all but one of the recurrent infections with no instances of vomiting after capsule ingestion, according to Thomas Louie, MD, of the University of Calgary in Alberta, Canada, and colleagues.

In the one instance of recurrence, repeat infection following treatment was associated with the patient's chronic reinfection elsewhere in the body, Louie reported during a press conference at the IDWeek meeting.

That reduction in "aesthetic issues in fecal transplant" seemed promising to Mary Hayden, MD, of Rush University Medical Center in Chicago, Ill. and co-chair of IDWeek. "If you can get around those issues with a pill that really works as well as we're being told microbiota transplants work, I think that's a fantastic advance," Hayden told MedPage Today.

Studies following outcomes of patients receiving fecal transplant have shown time and again that the therapy is safe and effective in quickly resolving symptoms with low rates of adverse events, but these therapies have been delivered through enemas, jejunal catheters, or colonoscopy.

Louie and colleagues studied the effectiveness of fecal transplant administered through gel caps in a population of 32 patients who were unable to tolerate a jejunal catheter and/or were unable to retain a fecal enema to treat their recurrent C. difficile infection.

Participants had more than three episodes of infection, were referred for fecal microbe transplant therapy, and had their infection controlled with oral vancomycin.

The capsules were assembled the day of the transplant. Feces donors provided roughly 100 grams of feces, which was suspended in 600 to 800 mL of saline, and was then centrifuged, decanted, and re-suspended to allow for micropipetting into 0.47 mL capsules, which were then each overcapsuled with #0- and #00-sized gelatin capsules.

Feces were collected from related donors mostly, and both donors and recipients were tested for bloodborne infections, parasites, and other invasive disease prior to transplant. The investigators did not use a stool bank or other forms of pooled feces in developing the pill-based treatment, Louie said at the conference.

Patients discontinued vancomycin treatment the day before the procedure and received a colonic cleansing the morning of the procedure. They received 24 to 34 fecal microbe capsules on an empty stomach, then were followed-up at 1 week, 1 month, 3 months, and 6 months after therapy, with additional follow-ups occurring up to 3 years.

The therapy was well-tolerated, Louie noted, and treatment completely resolved patients' symptoms after the single dose of pills.

"Your gut flora is part of your identity," Louie noted, raising that anti-C. difficile treatments don't necessarily wipe out the bug, but rather re-establish microbiome diversity. The reason recurrence occurs in many patients who receive antibiotic treatments is that the antibiotics may scramble that diversity, he explained.

He added that the "future is to know which bacteria are the kingpins of gut flora," with which healthcare professionals or possibly even pharmaceutical companies can "make true probiotic pills."

The authors declared they had no conflicts of interest.

Reviewed by F. Perry Wilson, MD, MSCE Instructor of Medicine, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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